Clinical Practice Midwifery

Family Planning Services

Oleh :
Nur Assyah

(130803022)

Shofiatin Ningsih (130803030)

Sri Anita

(130803033)

SEKOLAH TINGGI ILMU KESEHATAN PEMKAB JOMBANG

PRODI DIII KEBIDANAN
TAHUN 2014/2015

Clinical Practice Midwifery

Midwives practice independently have a great responsibility to be accountable for
their own what to do. In this case a worker Midwife Practice Self-free control of himself. This
situation will be immense influence on the possibility of ethical lapses. (Sofyan, et al. 2006).
Independent Practice Midwife (BPM) is a form of health care in the field of basic
health. The practice of midwives is a series of health services provided by midwives to
patients (individuals, families, and communities) in accordance with the authority and ability.
Midwife who practices should have a Permit Practice Midwife (SIPB) so that it can run on the
practice of health advice or program. (Imamate, 2012: 01)
Independent Practice Midwife (BPM) is a midwife who has a Midwife Practice
License (SIPB) in accordance with applicable requirements, noting (registers) legally licensed
and legal to run an independent midwifery practice.
Midwives practice independently (BPM) is an independent health care institutions that
provide care within the scope of midwifery practice. Midwifery practice is the application of
obstetrics in providing services or midwifery care to clients with obstetric management
approach.
Self-service practice midwife is a provider of health care, which has a significant
contribution in providing services, particularly in improving the well-being of the mother and
child. In order for service recipients midwife gain access quality services, the need for
regulation of the practice of midwifery services is clearly preparation before the midwife to
carry out services such as licensing practices, place, room, practice equipment, and
administrative requirements all must comply with the standards.
Establishment of Independent Midwives Practice Requirements
1. Become a member of IBI
2. Application Permit Practice Midwife as Private Individuals
3. Letter of the Head of the Local Regional Health Center Practice
4. Statement is not under sanctions profession / law.
5. Certificate of IBI Regional Branch Chairman
6. Preparation of medical equipment and medical businesses midwife practice individually
with the help of labor inspection services and care.
7. Make a Letter of Agreement which could comply with the written agreement.
8. Midwives in running practice should:

a. Having a place and practice rooms that meet the health requirements.
b. Provide a bed for a minimum of 1 and a maximum delivery 5 beds.
c. Have a minimum of equipment in accordance with the provisions and implement
standard operating procedures (SOPs) are applicable.
d. Providing medicines in accordance with the provisions of the applicable equipment.
9. The midwife who runs prakytek permit must include a copy of the practice of a midwife
or practice diruang practice, or a place that is easily seen.
10. Midwives in practice employ another midwife, who has SIPB to assist the ministry
11. The midwife who practices should have to have a minimum of equipment in accordance
with applicable regulations and equipment should be available in place practice.
12. Equipment that must be owned in practicing midwives in accordance with the type of
service provided.
13. In carrying out its duties and midwives must maintain and improve professional skills
among others:
a. Following the development of science and or exchange information with fellow
midwife.
b. Following the academic activities and training in their respective sectors, both
organized by the government and professional organizations.
c. Maintain and care for the equipment used to practice in order to remain ready and
functioning properly.
Services Provided Independent Practice Midwife. In midwives practice independently
provide services that include:
1. Health Counseling
2. Counseling KB
3. Antenatal Care (gymnastics pregnant, breast care)
4. Delivery Care
5. Postpartum Care (gymnastics parturition)
6. Baby Care
7. Family planning services (IUD, AKBK, injections, pills)
8. Immunization (Mother and Baby)
9. Adolescent Reproductive Health
BPM addition serves a community service, especially women and children,
should be able to also function as a community empowerment which also serves to
participate in community participation activities, for example:
a. growth monitoring sessions
b. foster neighborhood health center
c. membia cadre

d. fostering shaman
e. become a foster mother
f. fostering dasa homestead
g. become members of community organizations

Family Planning Services

1. Natural Family Planning

His method is when you do not have sex or use a barrier method on the days you are
most fertile (most likely to become pregnant). You can read about barrier methods in the
following chart.
A woman who has a regular menstrual cycle has about 9 or more days each month when
she is able to get pregnant. These fertile days are about 5 days before and 3 days after
ovulation, as well as the day of ovulation.
To have success with this method, you need to learn about your menstrual cycle. Then
you can learn to predict which days you are fertile or unsafe. To learn about your cycle,
keep a written record of:

When you get your period

What it is like (heavy or light blood flow)
How you feel (sore breasts, cramps)
This method also involves checking your cervical mucus and recording your body

temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile
when it is clear and slippery like raw egg whites. Use a basal thermometer to take your
temperature and record it in a chart. Your temperature will rise 0.4 to 0.8 F on the first day of
ovulation. You can talk with your doctor or a natural family planning instructor to learn how
to record and understand this information.
2. Barrier Methods Put up a block, or barrier, to keep sperm from reaching the egg
a) Contraceptive Sponge
This barrier method is a soft, disk-shaped device with a loop for taking it out. It is made
out of polyurethane (pah-lee-YUR-uh-thayn) foam and contains the spermicide (SPUR-muhsyd) nonoxynol-9. Spermicide kills sperm.
Before having sex, you wet the sponge and place it, loop side down, inside your vagina
to cover the cervix. The sponge is effective for more than one act of intercourse for up to 24
hours. It needs to be left in for at least 6 hours after having sex to prevent pregnancy. It must
then be taken out within 30 hours after it is inserted.
Only one kind of contraceptive sponge is sold in the United States. It is called the Today
Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.
b) Diaphragm, Cervical Cap, and Cervical Shield

These barrier methods block the sperm from entering the cervix (the opening to your
womb) and reaching the egg. The diaphragm is a shallow latex cup. The cervical cap is a
thimble-shaped latex cup. It often is called by its brand name, FemCap. The cervical shield is
a silicone cup that has a one-way valve that creates suction and helps it fit against the cervix.
It often is called by its brand name, Leas Shield.
The diaphragm and cervical cap come in different sizes, and you need a doctor to fit
you for one. The cervical shield comes in one size, and you will not need a fitting.Before
having sex, add spermicide (to block or kill sperm) to the devices. Then place them inside
your vagina to cover your cervix. You can buy spermicide gel or foam at a drug store.
All three of these barrier methods must be left in place for 6 to 8 hours after having sex
to prevent pregnancy. The diaphragm should be taken out within 24 hours. The cap and shield
should be taken out within 48 hours.
c) Female Condom
This condom is worn by the woman inside her vagina. It keeps sperm from getting into
her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant. It can
be inserted up to 8 hours before having sex. Use a new condom each time you have
intercourse. And dont use it and a male condom at the same time.
d) Male Condom
Male condoms are a thin sheath placed over an erect penis to keep sperm from entering
a womans body. Condoms can be made of latex, polyurethane, or natural/lambskin. The
natural kind do not protect against STIs. Condoms work best when used with a vaginal
spermicide, which kills the sperm. And you need to use a new condom with each sex act.
Condoms are either:
Lubricated, which can make sexual intercourse more comfortable. Non-lubricated, which
can also be used for oral sex. It is best to add lubrication to non-lubricated condoms if you
use them for vaginal or anal sex. You can use a water-based lubricant, such as K-Y jelly. You
can buy them at the drug store. Oil-based lubricants like massage oils, baby oil, lotions, or
petroleum jelly will weaken the condom, causing it to tear or break.
3. Hormonal Methods Prevent pregnancy by interfering with ovulation,
fertilization, and/or implantation of the fertilized egg
a) Oral Contraceptives Combined pill (The pill)

The pill contains the hormones estrogen and progestin. It is taken daily to keep the
ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the
cervical mucus to keep the sperm from joining the egg.
Some women prefer the extended cycle pills. These have 12 weeks of pills that contain
hormones (active) and 1 week of pills that dont contain hormones (inactive). While taking
extended cycle pills, women only have their period three to four times a year.
Many types of oral contraceptives are available. Talk with your doctor about which is
best for you. Your doctor may advise you not to take the pill if you:

Are older than 35 and smoke

Have a history of blood clots
Have a history of breast, liver, or endometrial cancer

Antibiotics may reduce how well the pill works in some women. Talk to your doctor
about a backup method of birth control if you need to take antibiotics.Women should wait
three weeks after giving birth to begin using birth control that contains both estrogen and
progestin. These methods increase the risk of dangerous blood clots that could form after
giving birth. Women who delivered by cesarean section or have other risk factors for blood
clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.
b) The Patch
Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen,
buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the
bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the
cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch
once a week for 3 weeks. You dont use a patch the fourth week in order to have a period.
Women should wait three weeks after giving birth to begin using birth control that
contains both estrogen and progestin. These methods increase the risk of dangerous blood
clots that could form after giving birth. Women who delivered by cesarean section or have
other risk factors for blood clots, such as obesity, history of blood clots, smoking, or
preeclampsia, should wait six weeks.
c) Shot/Injection
The birth control shot often is called by its brand name Depo-Provera. With this method
you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months.

A new type is injected under the skin. The birth control shot stops the ovaries from releasing
an egg in most women. It also causes changes in the cervix that keep the sperm from joining
with the egg.
The shot should not be used more than 2 years in a row because it can cause a temporary
loss of bone density. The loss increases the longer this method is used. The bone does start to
grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if
used for a long time.
d) Vaginal Ring
This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by
stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the
sperm from joining the egg. It is commonly called NuvaRing, its brand name. You squeeze
the ring between your thumb and index finger and insert it into your vagina. You wear the ring
for 3 weeks, take it out for the week that you have your period, and then put in a new ring.
Women should wait three weeks after giving birth to begin using birth control that
contains both estrogen and progestin. These methods increase the risk of dangerous blood
clots that could form after giving birth. Women who delivered by cesarean section or have
other risk factors for blood clots, such as obesity, history of blood clots, smoking, or
preeclampsia, should wait six weeks.
4. Implantable devices Devices that are inserted into the body and left in place for a
few years.
a) Implantable Rod
This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is
often called by its brand name, Implanon. The rod releases a progestin, which causes changes
in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less
often, it stops the ovaries from releasing eggs. It is effective for up to 5 years.
b) Intrauterine Devices or IUDs
An IUD is a small device shaped like a T that goes in your uterus. There are two types:

Copper IUD

The copper IUD goes by the brand name ParaGard. It releases a small amount of copper
into the uterus, which prevents the sperm from reaching and fertilizing the egg. It fertilization

does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A
doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years.

Hormonal IUD

The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine
system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an
egg and causes the cervical mucus to thicken so sperm cant reach the egg. It also affects the
ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a
hormonal IUD. It can stay in your uterus for up to 5 years.
5. Permanent Birth Control Methods For people who are sure they never want to
have a child or they do not want more children
a) Sterilization Implant (Essure)
Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a
tiny spring-like device through the vagina and uterus into each fallopian tube. The device
works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops
the egg and sperm from joining. It can take about 3 months for the scar tissue to grow, so its
important to use another form of birth control during this time. Then you will have to return to
your doctor for a test to see if scar tissue has fully blocked your tubes.
b) Surgical Sterilization
For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This
stops the eggs from going down to the uterus where they can be fertilized. The surgery can be
done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at
the same time, so as to avoid having additional surgery later.
For men, having a vasectomy (vuh-SEK-tuh-mee) keeps sperm from going to his penis, so his
ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3
months. During that time, use a backup form of birth control to prevent pregnancy. A simple
test can be done to check if all the sperm is gone; it is called a semen analysis.
6. Emergency Contraception Used if a womans primary method of birth control
fails. It should not be used as a regular method of birth control.
a) Emergency contraception (Plan B One-Step or Next Step. It is also called the
"morning after pill.")

Used if a womans primary method of birth control fails. It should not be used as a
regular method of birth control. Emergency contraception (Plan B One-Step or Next Step. It is
also called the "morning after pill.") Emergency contraception keeps a woman from getting
pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no
method of birth control was used. It can also mean that a birth control method was used but it
was used incorrectly, or did not work (like a condom breaking). Or, a woman may have
forgotten to take her birth control pills. She also may have been abused or forced to have sex.
These are just some of the reasons women may need emergency contraception.
Emergency contraception can be taken as a single pill treatment or in two doses. A single
dose treatment works as well as two doses and does not have more side effects. It works by
stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg.
For the best chances for it to work, take the pill as soon as possible after unprotected sex. It
should be taken within 72 hours after having unprotected sex. A single-pill dose or two-pill
dose of emergency contraception is available over-the-counter (OTC) for women ages 17 and
older.

DAFTAR PUSTAKA

https://www.midwiferycouncil.health.nz/midwifery-scope-of-practice/
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